As we look back on the history of the Journal for Nurses in Professional Development's Simulation Column that started in 2013, the inaugural column titled Simulation for the Nursing Professional Development Specialist: There Is Nothing Fake About It (Holtschneider, 2013) challenged nursing professional development (NPD) practitioners to encourage learners to suspend their disbelief so that all involved would treat simulation exercises as real. Though important in both the academic and clinical environment, the ability to treat simulations as real in the clinical setting helps not only the learning process but also the identification of systems and process issues, particularly when we perform in situ unannounced simulations. By identifying and fixing issues related to systems, processes, and latent threats, we as NPD practitioners can make broad impact in our workplaces, which ultimately affects patient care. This theme has been woven throughout subsequent Simulation columns.
Learning from the Past
Regardless of academic or clinical setting, simulation over the years has been often linked to the use of high-fidelity manikins. These life-sized human replicas were widely adopted throughout preprofessional nursing and medical schools due to their anatomic integrity and physiological control features that increase the realism of the learner/patient encounter. The operator controlled scalable feature allowed for simulation scenarios to range from basic patient encounters to complex medical emergencies that can be used to train teams of advanced learners, which was quite novel during the early development stages. Armed with this new found ability to program and automate a manikin's cardiac, respiratory, and neurological responses and to change important vital signs with the touch of the mouse (also known as "on the fly"), many healthcare facilities began investing in simulation technicians, educators, and formal simulation centers and/or programs.
Not surprisingly, many of us whose role includes simulation education got our start largely because of widespread adoption of these high-fidelity manikins in our healthcare facilities. Today, many preprofessional programs and hospital systems use high-fidelity simulation manikins to facilitate important clinical skills acquisition and interprofessional team training for responses to emergency situations. To increase the realism and to add to complex multimodal training, many have integrated other modalities, such as standardized patients, partial task trainers, virtual reality features, computer-based applications, and hybrid forms of simulation to expand the use of manikins.
Over the years, we have become increasingly aware of the importance of verbal communication and listening skills to be taught alongside the psychomotor skills development. Concepts such as emotional intelligence, mindfulness, skilled communication, and effective teamwork have become buzzwords throughout the healthcare settings, as these nontechnical skills have proven to be tremendously overshadowed by the demand for technical training. As NPD practitioners, we must remember that our personal talent as educators, leaders, change agents, and so forth are what we bring to all educational settings to improve learner engagement, reflection, and iterative practice. To help accomplish this mission, we offer a variety of simulation techniques or strategies that have been field tested and proven to deliver. In the final analysis, our learners come to our offerings because of us and our unique contributions to their learning, not because of the bells and whistles of highly technologically advanced simulations that we offer (Holtschneider, 2014).
Looking To the Future
As we peer into the future, we envision an era that will place greater emphasis on three areas. First is the integration of simulation practice with NPD responsibilities. Second is interprofessional practice and team training. Third is the use of technology to enhance the experiential learning environment. In order to address these challenges that await us, it will be imperative for us to develop increasing numbers of NPD practitioners who are familiar with simulation techniques and how they can be leveraged to achieve our educational endeavors.
Let's take a look at each of these areas:
Integration of simulation with NPD responsibilities: Simulation as a field grew separately from NPD practice as much of its roots are in academic preprofessional programs. Yet, NPD practitioners have been using simulation techniques to some degree for a long time, often without referring to these techniques using simulation-related terms, such as "high fidelity" or "debriefing." We currently see some NPD practitioners using simulation-based learning to increase interactivity during annual competency evaluation, orientation/onboarding, emergency response drills, and interprofessional teamwork scenarios. We see this integration becoming the norm in the next few years, rather than a novel approach to designing and implementing educational offerings. We also see NPD practitioners not only using simulation for education but increasingly for process improvement, systems improvement, evaluation of learning, and other areas beyond education and training.
Interprofessional practice and team training: We believe that, as an NPD community, we have only touched the surface of what interprofessional teamwork and communication means. Though simulation has been widely used to teach these important concepts, how have we made a difference in outcomes, systems, and processes? The 2016 updated Core Competencies for Interprofessional Collaborative Practice affirmed the importance of maintaining a climate of mutual respect and shared values/ethics, knowing one's roles/responsibilities, communicating interprofessionally in a responsive and responsible manner, and performing effectively in teams (Interprofessional Education Collaborative, 2016). These competencies are increasingly being implemented in a variety of preprofessional schools.
As more and more graduates from preprofessional programs are being exposed to this type of education, how are we as NPD practitioners ensuring that our practicing clinicians are also demonstrating these competencies? Are we consciously partnering with our academic colleagues to ensure seamless transition from graduation to clinical practice with respect to these interprofessional competencies?
We believe simulation can be useful to help both students and clinicians practice these competencies. Our challenge as NPD practitioners is designing, developing, and implementing simulation scenarios that incorporate these competencies and encourage exploration of specific roles and responsibilities of each of the professions involved. During the debriefing, we can facilitate learner discussion on how each of their roles is essential to the team and the care of the patient (Park & Holtschneider, 2016). An even broader challenge is to seek ways to demonstrate how interprofessional collaboration improves outcomes, as challenged by the Institute of Medicine (2015) in their report, Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes.
Use of technology to enhance the experiential learning environment: Simulation has certainly propelled forward our use of technology for teaching and learning. Computerized manikins, haptic devices that provide a realistic "feel" for how to perform a procedure, computer-based games, virtual reality, and augmented reality are all ways that we can incorporate technology into our simulation scenarios. As technology continues to develop, how do we optimally use it to achieve our desired outcomes, such as competency determination, skills acquisition, proficiency maintenance, and interprofessional teamwork and communication? This question will move further to the forefront as technological applications grow and permeate our environment.
A glimpse of our past, present, and future of simulation shows an enormous change, which brings opportunities for NPD practitioners to expand our influence in the educational domain. Our attitude and approach to this simulation future hold limitless potential to transform our healthcare environment. How do you see this impacting you and your practice? E-mail us at mailto:[email protected] and mailto:[email protected] to share your thoughts on the past, present, and future of simulation.
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